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Thread: What's the prognosis for untreated lumbar scoliosis?

  1. #16
    Join Date
    May 2010
    Location
    Indianapolis area
    Posts
    966
    Jess,

    John Dietz at OrthoIndy (top orthopedic hospital in Indiana and he's an SRS doctor) said that about the pain after fusing to L4-L5. I have also read studies that suggest there is a high probability of pain after fusing to that area (but not lower). Also there's an almost certainty of disk degeneration.

    Right now I don't much disk degeneration or pain, hence the waffling. However, Dr. Bridwell convinced me that this is likely to come (sadly)! He wants to fuse to sacrum with pelvic fixation. And I think that is the difference. Assuming you don't fracture your fixation there, I think fusing that low is supposed to relieve the pain, though you give up more flexibility.

    Actually, I would like to start a new thread on the L5 vs. sacrum debate, but I need to do a search first. It's an interesting question that even the doc seem to still be debating.

    But, bottom line for you is it sounds like surgery WOULD reduce your pain. The fact that you have more to begin with and that they're definitely fusing to sacrum make the difference (I think!).

    Evelyn
    age 44
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke, T4 to S1 with pelvic fixation
    Not "confused" anymore, but don't know how to change my username.

  2. #17
    Join Date
    May 2010
    Location
    Indianapolis area
    Posts
    966
    P.S. Linda, thanks once again for the helpful input!

    P.P.S. I'm not sure I trust the doctor who made the comment about little old ladies coming in for their injections and getting along fine. I'm sure this is true for some, but the probability with a 68* curve at age 38 seems low.
    age 44
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke, T4 to S1 with pelvic fixation
    Not "confused" anymore, but don't know how to change my username.

  3. #18
    Join Date
    May 2010
    Location
    Indianapolis area
    Posts
    966

    Quality of Life 2 Years After Surgery and Non-Surgery

    Re-posting a study Linda put up a year ago....conclusion is basically lumbar patients do better with surgery.

    Spine (Phila Pa 1976). 2009 Sep 15;34(20):2171-8.Click here to read Links
    Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study.
    Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D.

    Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. bridwellk@wudosis.wustl.edu

    STUDY DESIGN: Prospective observational cohort study with matched and unmatched comparisons. Level II evidence. OBJECTIVE: The purpose of this study is to compare results of adult symptomatic lumbar scoliosis (ASLS) patients treated nonoperatively and operatively. This is an evidence-based prospective multicenter study to answer the question of whether nonoperative and operative treatment improves the quality of life (QOL) in these patients at 2-year follow-up. SUMMARY OF BACKGROUND DATA: Only 1 paper in the peer-reviewed published data directly addresses this question. That paper suggested that operative treatment was more beneficial than nonoperative care, but the limitations relate to historical context (all patients treated with Harrington implants) and the absence of validated patient-reported QOL (QOL) data. METHODS: This study assesses 160 consecutively enrolled patients (ages 40-80 years) with baseline and 2-year follow-up data from 5 centers. Lumbar scoliosis without prior surgical treatment was defined as a minimum Cobb angle of 30 degrees (mean: 54 degrees for patients in this study). All patients had either an Oswestry Disability Index (ODI) score of 20 or more (mean: 33) or Scoliosis Research Society (SRS) domain scores of 4 or less in pain, function, and self-image (mean: 3.2) at baseline. Pretreatment and 2-year follow-up data collected prospectively included basic radiographic parameters, complications and SRS QOL, ODI, and Numerical Rating Scale back and leg pain scores. RESULTS: At 2 years, follow-up on the operative patients was 95% and for the nonoperative patients it was 45%. The demographics for the nonoperative patients who were followed up for 2 years versus those who were lost to follow-up were identical. The operative cohort significantly improved in all QOL measures. The nonoperative cohort did not improve and nonsignificant decline in QOL scores was common. At minimum 2-year follow-up, operative patients outperformed nonoperative patients by all measures. CONCLUSION: It would appear from this study that common nonoperative treatments do not change the QOL in patients with ASLS at 2-year follow-up. However, operative treatment does significantly improve the QOL for this group of patients. Our conclusions are limited by the fact that we were only able to follow-up 45% of the nonoperative group to 2-year follow-up, in spite of extensive efforts on our part to accomplish such.
    age 44
    80* thoracolumbar; 40* thoracic
    Reduced to ~16* thoracolumbar; ~0* thoracic
    Surgery 3/14/12 with Dr. Lenke, T4 to S1 with pelvic fixation
    Not "confused" anymore, but don't know how to change my username.

  4. #19
    Join Date
    May 2009
    Posts
    3,745
    hah..just goes to show if you find medical stuff that says one thing, look a while and you'll find some that says the opposite!

    perhaps the thread could have been titled "outcome fusing L5 vs. to sacrum/pelvis"...might have been more descriptive of question...?

    i have been told that between sacrum and pelvis being fused, there is little difference in what one can do after surgery....
    i know there is a big difference fusing to L5 vs. to sacrum, and that is one reason some folks on forum have practically begged their surgeons to stop at L5!! they have said as much on here...

    there is also no guarantee that if one has fusion to L5 that person will need revision later...but i do think there are lots of times that it appears likely...i think it would be wise, in those cases, to fuse lower...but i know a lot of patients resist...(all that begging)...i guess they can look at it as buying some time...but isn't it not wise to go against a good surgeon's recommendations...??!

    jess
    Last edited by jrnyc; 07-01-2010 at 07:49 AM.

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